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Manual and Vacuum Aspiration for Abortion

Surgery Overview

There are two methods of vacuum aspiration
(also called suction aspiration):

Manual vacuum. This procedure can be used around
5 to 12 weeks after the last menstrual period (early
first trimester). It involves the use of a specially
designed syringe to apply suction. This method is not available everywhere. But
it may be more available than machine aspiration in some geographic
areas.

Machine vacuum. This procedure is a common method
used in the first 5 to 12 weeks (first trimester) of pregnancy. Machine vacuum
aspiration involves the use of a hollow tube (cannula) that is attached by
tubing to a bottle and a pump, which provides a gentle vacuum. The cannula is
passed into the uterus, the pump is turned on, and the tissue is gently removed
from the uterus.

Insert a small
instrument into the cervix to slightly open (dilate) it, if needed. In most
cases, though, dilation isn't needed.

Pass a thin tube through
the cervix and into the uterus. A handheld syringe is attached and used to
suction the tissue out of the uterus. As the uterine tissue is removed, the
uterus will contract. Most women feel cramping during the procedure. The cramps
will decrease after the tube is removed. Some women also have nausea or sweating,
or they feel faint. But typically symptoms are less severe than with machine
vacuum aspiration.

Machine vacuum aspiration procedure

Hours before
or the day before a machine vacuum aspiration procedure, a
cervical (osmotic) dilator may be placed in the cervix
to slowly open (dilate) it. Just before, antibiotics are given to prevent
infection. A medicine called misoprostol may be given to soften the cervix
before the procedure.

Machine vacuum aspiration usually takes
between 10 and 15 minutes. It can be done safely in a clinic or medical office
under local anesthetic. For this procedure, the health professional will:

Position you on the exam table in the same
position used for a pelvic exam, with your feet on stirrups while lying on your
back.

Insert a speculum into the vagina.

Clean
the vagina and cervix with an antiseptic solution.

Inject a
numbing medicine (local anesthetic) in the cervix. Medicine for pain or
sedation, in addition to the local anesthetic, may be given by mouth or through
a vein (intravenously). Vasopressin, or a similar medicine
that slows uterine bleeding, may be mixed with the local anesthetic to reduce
blood loss.

Grasp the cervix with an instrument to hold the
uterus in place.

Open (dilate) the cervical canal with a small
instrument. Dilation reduces the risk of any injury to the cervix during the
procedure.

Pass a thin, hollow tube (cannula) into the cervical
canal and attaching a gentle vacuum that will draw the tissue out of the
uterus. As the uterine tissue is removed, the uterus will contract. Most women
feel cramping during the procedure. The cramps will decrease after the tube is
removed. Some women also may have nausea or sweating or feel faint.

The tissue removed from the uterus during a vacuum
aspiration procedure is examined to make sure that all of the tissue has been
removed and the abortion is complete.

Sometimes a
dilation and curettage (D&C) procedure is
needed after a vacuum aspiration if all of the tissue has not been removed.
D&C uses a sharp surgical instrument to clear tissue from the uterus.

What To Expect After Surgery

Irregular bleeding or spotting for the first 2
weeks. During the first week, avoid tampons and use only
pads.

Cramps similar to menstrual cramps. These may be present for
several hours and possibly for a few days, as the uterus shrinks back to its
nonpregnant size.

Emotional reactions for 2 to 3
weeks. After an abortion, it is normal to feel relief, sadness, grief, or guilt. Hormonal changes during pregnancy can make emotions stronger than usual.

After the procedure:

Take your full course of prescribed antibiotics
to prevent infection.

Rest quietly for the day. You can do normal
activities the following day, based on how you feel.

Acetaminophen
(such as Tylenol) or ibuprofen (such as Advil) can help relieve cramping
pain.

Do not have sexual intercourse for at least 1 week. Use
birth control following the abortion. And use condoms to prevent infection. You
can start certain birth control methods right after the procedure.

Signs of complications

Call your doctor immediately if you have
any of these symptoms after an abortion:

Severe bleeding. Both medical and surgical
abortions usually cause bleeding that is different from a normal menstrual
period. Severe bleeding can mean:

Passing clots that are bigger than a
golf ball, lasting 2 or more hours.

Soaking more than 2 large pads
in an hour, for 2 hours in a row.

Bleeding heavily for 12 hours in
a row.

Signs of infection in your whole body, such as
headache, muscle aches, dizziness, or a general feeling of illness. Severe
infection is possible without fever.

Severe pain in the abdomen
that is not relieved by pain medicine, rest, or heat

Hot flushes or a fever of
100.4°F (38°C) or higher that
lasts longer than 4 hours

Vomiting lasting more than 4 to 6
hours

Sudden abdominal swelling or rapid heart
rate

Vaginal discharge that has increased in amount or smells
bad

Pain, swelling, or redness in the genital area

Call your doctor for an appointment if you have had any of these symptoms after a recent
abortion:

Bleeding (not spotting) for longer than 2
weeks

New, unexplained symptoms that may be caused by medicines
used in your treatment

No menstrual period within 6 weeks after the
procedure

Signs and symptoms of
depression. Hormonal changes after a pregnancy can
cause depression that requires treatment.

Why It Is Done

Vacuum aspiration is done in the first
trimester of pregnancy.

Vacuum aspiration can be done for:

An induced therapeutic abortion.

A
failed medical abortion.

Death of the fetus (missed spontaneous abortion).

An
incomplete miscarriage (incomplete spontaneous abortion).

How Well It Works

First-trimester surgical abortions
are safe and effective and have few complications.

In rare cases,
an aspiration procedure doesn't successfully end a pregnancy. This is more
likely to happen during the earliest weeks of a pregnancy.

Risks

The risk of complications is low. Some
minor complications include:

Injury to the uterine lining or
cervix.

Infection. Bacteria can enter the uterus during the
procedure and cause an infection. This is more likely if an untreated infection,
such as a
sexually transmitted infection (STI), is present before
the procedure. Symptoms of fever, pain, and abdominal (belly) tenderness will usually
start within 3 days of the procedure. Antibiotics given during or after
the procedure reduce the risk of infection.

Rare complications include:

A hole in the wall of the uterus (uterine
perforation). This is rare. This most commonly happens during cervical dilation. Bleeding is usually minimal, and no repair is needed.
If bleeding is a concern, a
laparoscopy (a procedure that uses a lighted viewing
instrument) can be used to see whether it has stopped.

Tissue
remaining in the uterus (retained products of conception). This usually causes recurring cramping belly pain and bleeding within a week of the procedure.
Sometimes prolonged bleeding does not develop until several weeks
later.

Blood clots. If the uterus doesn't contract to pass all of
the tissue, the cervical opening can become blocked, preventing blood from
leaving the uterus. The uterus becomes enlarged and tender, often causing
belly pain, cramping, and nausea.

A repeat
vacuum aspiration and medicine to stop bleeding are
used to treat retained products of conception or blood clots.

It is possible to have an undiagnosed
ectopic (tubal) pregnancy that isn't discovered until
after an abortion procedure. Although the pregnancy test before the procedure
is positive, the pregnancy is not in the uterus. So the abortion method does
not end the pregnancy. Symptoms of an ectopic pregnancy that occur after an
abortion procedure can include:

What To Think About

Choosing a medical or a surgical
procedure for an abortion will depend on your medical history, how many weeks
pregnant you are, what options are available where you live, and your personal
preferences.

In the United States,
vacuum aspiration is the most common method of
abortion used within the first 12 weeks (first trimester) of pregnancy. Early in pregnancy through most of the first
trimester, a woman can also consider using medicine (medical abortion).

Nearly 90 out of 100 abortions are done in the first trimester of
pregnancy.footnote 1

Before your procedure

The hospital or surgery center may send you instructions on how to get
ready for your surgery. Or a nurse may call you with instructions before your
surgery.

After your procedure

Right after surgery, you will be taken to a recovery
area where nurses will care for and observe you. You most likely will stay in
the recovery area for a period of time and then you will go home. In
addition to any special instructions from your doctor, your nurse will explain
information to help you in your recovery. You will go home with a page of care
instructions including who to contact if a problem arises.

An abortion rarely affects
your ability to become pregnant in the future. So it is possible to become
pregnant in the weeks right after the procedure. Avoid sexual intercourse until
your body has fully recovered, usually for at least 1 week. Use birth control
in the first weeks following the abortion. And use condoms to prevent
infection.

Depression can be triggered when pregnancy hormones
change after an abortion. If you have more than 2 weeks of symptoms of
depression, such as fatigue, sleep or appetite change, or feelings of sadness,
emptiness, anxiety, or irritability, see your doctor about treatment.

Guttmacher Institute (2011). In Brief: Facts on Induced Abortion in the United States. Available online:
http://www.guttmacher.org/pubs/fb_induced_abortion.html.

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